- Community Health Systems (Fort Smith, AR)
- As a Remote Medical Denials / Appeals Specialist at Community Health Systems - Shared Services Center, you'll play a vital role in supporting our purpose ... flexible scheduling, 401k and student loan repayment programs. The Remote Medical Denials / Appeals Specialist position is remote and full time,… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist II will be responsible for the initial analysis of appeals correspondence, and determination of ... to assist medical professional staff in performing the review of appeals and reconsiderations. Prioritize, research, analyze, and perform accurate data entry for… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …will consider collective experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, ... appeal/grievance requests and electronic inquiries in order to identify and classify appeals and grievances as outlined in policies and procedures. Using internal… more
- Community Health Systems (Franklin, TN)
- …Duties and Responsibilities:** include the following. Other duties may be assigned. + File medical necessity and level of care appeals using InterQual and CMS ... persons. + Maintain documentation regarding all payor resources regarding denials and appeals processes. + Understand and apply CHS 10-Step Appeal Process for denied… more
- Community Health Systems (Sarasota, FL)
- **Job Summary** The Appeals Specialist I is responsible for reviewing patient accounts denied for insurance reimbursement or paid incorrectly and following ... to resolve discrepancies and improve reimbursement rates. As an Appeals Specialist I at Community Health Systems,...activity in the Appeal Tracker. + Submits requests for medical records, ub's, and itemized bills as needed. +… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Training Specialist II Job Category: Customer Service Department: CSC Training & Performance Location: Los ... net required to achieve that purpose. Job Summary The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for… more
- Northwell Health (Melville, NY)
- **Req Number** 144826 Remote Work Schedule: Sun-Thurs/8AM-4PM Job Description Reviews and responds to Corporate Compliance Audits and serves as a resource for the ... and the third party payer. Prepares and defends level of care and medical necessity for assigned case. Collaborates with physician advisor, payor representative and… more
- LA Care Health Plan (Los Angeles, CA)
- …and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing feedback on ... Lead Customer Solution Center Appeals and Grievances Job Category: Administrative, HR, Business...and or process improvement. Assist Supervisor to ensure that Specialist provide accurate, timely, and quality responses. Ensure that… more
- University of Michigan (Ann Arbor, MI)
- Revenue Cycle Coding Supervisor - Appeals & Denials Apply Now **Job Summary** The Denial Coding Supervisor provides subject matter expertise in physician medical ... activities. This position oversees the Physician Billing (PB) Denial Coders and Appeals and Denial Coordinators, ensuring the accuracy and efficiency of denial… more
- Veterans Affairs, Veterans Health Administration (IN)
- …needs. As a member of the VISN 22 CSP's Centralized Eligibility and Appeals Team (CEAT), the incumbent has the responsibility for expert knowledge of eligibility ... and VACO CSP to develop and implement strategies for PCAFC determinations, appeals process, and performance improvement. Evaluating program progress and outcomes and… more
- Weill Cornell Medical College (New York, NY)
- Title: Revenue Cycle Specialist -Revenue Integrity ( Remote ) Location: Midtown Org Unit: AR - Coding Medicine Work Days: Weekly Hours: 35.00 Exemption Status: ... claim status and billing guidelines to substantiate corrected claim submissions, written appeals , coding and medical necessity reviews. + Researches and… more
- St. Luke's University Health Network (Allentown, PA)
- …, case resolution, and impact on revenue and trending. + Coordinates RAC appeals for complex case reviews for medical necessity, including determining if ... ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for... reviews inpatient CMS and third party denials for medical necessity and tracks outcomes regarding appeal process. Assists… more
- Robert Half Accountemps (Indianapolis, IN)
- …a Healthcare client of ours to secure a tenured Medical Accounts Receivable Specialist to work in a fully remote environment. This specialist must ... collection, efficient claim resolution, and precise financial record-keeping. The specialist will collaborate with insurance providers, patients, and internal teams… more
- Trinity Health (Livonia, MI)
- …Clinic for International Classification of Diseases, Clinical Modification + The American Medical Association _(AMA_ ) for CPT codes and CPT Assistant + American ... (PBS) teams, when needed, to help resolve billing, claims, denial and appeals issues affecting reimbursement. Maintains CEUs as appropriate for coding credentials as… more
- PeaceHealth (Vancouver, WA)
- **Description** **PeaceHealth is seeking a Billing/Follow-up Specialist - Commercial Billing for a Full Time, 1.00 FTE, Day position.** The salary range for this job ... insurance accounts and identify delays in processing. + Drafts appeals to insurance companies for reimbursement of monies owed....and + Formal training or college coursework from a medical coding accredited school, specific to medical … more
- CVS Health (St. Paul, MN)
- … adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Insures all compliance requirements are satisfied and all… more
- State of Colorado (Denver, CO)
- Civil Rights Investigator - HR Specialist III - Hybrid Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4770376) Apply Civil Rights ... Investigator - HR Specialist III - Hybrid Salary $57,708.00 - $75,024.00 Annually Location Denver Metro, CO Job Type Full Time Job Number IHA 04502 01/01/2025… more
- CareFirst (Baltimore, MD)
- …and quality monitoring organizations (NCQA). + Builds and maintains high performance complex medical networks to support the needs of the market and our clients. + ... hospitalist, diabetes education, reduction of authorizations, reduction of claims appeals , etc.). Participate in internal and external committees and workgroups,… more
- Medical Mutual of Ohio (OH)
- Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.6 million ... including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Medical Mutual' s status as a mutual company means we are owned by our… more
- Robert Half Accountemps (Tucson, AZ)
- Description Our client, in the medical industry, is in need for two Medical Billing/Collections Specialist to join their team on a long-term contract! This ... Tucson, and will be a hybrid work model, with remote work being the primary focus after the initial...permanent for the right individual. Key Responsibilities: * Processing medical billing and claims efficiently and accurately. * Handling… more